Senior hospitalists get new hires up to speed

Where: Spectrum Health Medical Center, which has 2 main campuses with 1,102 beds in the Grand
Rapids, Mich., area.

The issue: Improving the onboarding process for new hospitalists.

Background

Before 2015, the process of joining the 71-hospitalist acute care division at Spectrum
Health was fragmented, human resources surveys showed. New hospitalists described
orientation as front-loaded, inconsistent, and lacking peer assistance, said Muhammad
Nabeel, MD, FACP, a senior hospitalist in the division and clinical assistant professor
at the Michigan State University College of Medicine in Grand Rapids.

“There was a variable shadowing process. Providers were educated on the process
by our practice manager and site lead, and that varied with the new hires' previous
experience,” he said.

To tackle these issues, Dr. Nabeel implemented and coordinated a structured peer mentorship
program for new hires.

How it works

The program acclimates new physicians by pairing each with a senior hospitalist colleague
for a total of 4 working weeks. For their first 3 days, new hospitalists only shadow
their respective mentors, walking into patients' rooms and learning the various unit
dynamics. “That is the most crucial phase,” Dr. Nabeel said. During
this time, the mentors carry half the average daily census (about 6 to 8 patients)
and teach a standardized protocol for introductions, communicating with nurses, and
discussing plans of care with patients, he said.

Using a comprehensive checklist, the mentor also communicates expectations regarding
documentation, handoffs, roles of different shifts, and other duties. “That
checklist is quite rigorous and time intensive, with a certain degree of iterations
to make sure that we are explaining the process as clearly as possible,” Dr.
Nabeel said.

From day 4 to day 7 (the hospitalists have a 7-on/7-off schedule), new hires average
10 to 12 patients per day until working up to the average 15-patient daily census,
while the mentor carries 2 fewer patients than average. “The purpose is to
make sure there is collaboration if the new hire needs any assistance, [that] the
mentor is available to answer questions or walk through any challenging processes,”
Dr. Nabeel said. The formal peer mentorship continues for 4 weeks of work, with the
mentor and mentee meeting to discuss progress and review any questions at the end
of the second week and again at the end of the fourth week. But the relationship doesn't
end.

“The first thing I hear from my mentee is that if she has any questions, she
will connect and ask me. It has been a rewarding experience for both of us as we learn
new things every day,” Dr. Nabeel said.

Results

From June to December 2015, 11 hospitalists were trained under the new program. To
get feedback, Dr. Nabeel conducted an online survey of all new hospitalists that asked
questions pertaining to work efficiency and job satisfaction. Overall, 95% of the
answers were either very positive or positive, he reported. “In fact, some
of the feedback helped us further tweak the program to provide exposure to admitting
shifts,” he said. The estimated cost of the program, based on the reduced number
of patients seen, was about $2,400 to $3,600 per hire. “Given the feedback
that we have received, the fact that our new hires were so satisfied and the transition
was smooth, [the cost] is very absorbable with the return on investment in the form
of higher provider satisfaction, morale, and overall benefiting the culture of the
division,” Dr. Nabeel said.

Challenges

Variation in the speed of credentialing was a challenge at first. “Sometimes
we had to change the schedule because we could not get an accurate start date”
and had to pair the new hire with a different mentor, Dr. Nabeel explained. To address
this, he said, the program held off on pairing hospitalists until receiving a confirmed
start date. Although the group has residents and does some teaching, it is not an
academic hospitalist program, he noted. “The culture of mentorship or coaching
does not come naturally to most service-oriented hospitalist groups,” Dr. Nabeel
said.

Next steps

About 6 new hires are set to join the group this fall, and they'll go through the
same onboarding process, which has become a permanent fixture for all new hires in
the division, Dr. Nabeel said. The group has also expanded the program, tailoring
a variation for its locum tenens clinicians, he said. “Given the success of
this in regard to work ethic and workflow, we want all hospitalists working at both
campuses to represent a homogenous standard,” he said.

Words of wisdom

“This program gives us an opportunity where we can get to know each other as
a team and build a culture and camaraderie within our division....It is a tangible
way of saying that we care,” Dr. Nabeel said. “Their future is our future,
and our future is their future.”

ACP Hospitalist provides news and information for hospitalists, covering the major issues in the field. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated.